The Southeastern Pennsylvania Story HealthShare Exchange of Southeastern PA, Inc (HSX)

1. Health Information Exchange 2014: Connecting via Regional, State, and National EffortsThe Children’s Hospital of Philadelphia’s Seventh Annual Mid-Atlantic Healthcare Informatics Symposium on Friday, April 25, 2014

2. The Southeastern Pennsylvania StoryHealthShare Exchange of Southeastern PA, Inc (HSX) Martin Lupinetti, MBA Jonathan Sternlieb, MD

3. Disclosure • I, Martin Lupinetti,disclose that neither I nor my partner have relevant financial relationships with commercial interests. • I, Jonathan Sternlieb, disclose that neither I nor my partner have relevant financial relationships with commercial interests.

4. Learning Objectives • At the conclusion of this activity, the learner should be better able to: • Understand HealthShare Exchange’s history and unique model • Understand HSX present state • Understand HSX challenges and future goals

5. 2013 – An Exciting First Year of HSX!! HEALTHSHARE EXCHANGE WENT LIVE IN 2013! Governance, Board and HIO in Place! Secured Four-year Commitments by 37 Hospital Systems and Three Health Plans Members! Three-time Grant Recipient! HealthShare Exchange Connectivity in 2013!

6. HSX Context: Geography The five-county region represents the largest and most densely populated healthcare marketplace in the Commonwealth: • 32% of all consumers live in the region • 36% of all hospital discharges in the State (PA DOH FY2010 Hospital reports, all hospital discharges (acute, specialty and federal hospitals)) • 39% of Pennsylvanian’s births occur in the region (PA DoH report 2009) • 42% of all Medicaid admissions in the State (PHC4 County Utilization Reports for CY 2010)

7. “Enhanced” Direct Health Plan IDs PCP/Care Team, Routes to Care Manager Hospital Sends inpatient and ED discharge information Provider (eg PCPs, specialists, home health) Receives info via EHR, email or via health plan portal Use Case #2 – Claims History – Q4’14 Enhanced by Payers Delivering Claims Data. 3. Eligibility Request triggers plan to request medication history and claims data Health Plan Claims Data 2. Provider requests eligibility and clinical history from Health Plan 4. Information returned via PDF or CCD which can be consumed by EHR 1. Patient visits Provider (hospital or practice) 5. Provider receives data via EHR or secure email in support of medication reconciliation and treatment Use Case #1 - Discharge Information – Q3 ‘14 Enhanced by Payers Routing Intelligence.

8. HSX and CDA • Primary currency for health information exchange • Important for scalability at regional, state, national and international level • Based on Extensible Markup Language (XML) - HL7 Version 3 • Leverages controlled terminologies • SNOMED-CT, Logical Observation Identifier Names and Codes (LOINC), RxNorm, etc.. • Facilitates Incremental Interoperability • can begin with a simple CDA, can add structured data elements over time • Level 1 (most simple) to Level 3 (completely machine readable) • Enables re-use of CDA templates & document types in multiple applications • Supports re-use of clinical data for reporting (public health, quality measures, registries) • Healthcare Associated Infections (NHSN/CDC), • Quality Data Reporting Architecture (QRDA) • Cancer Reporting, etc… • Allows use of validation tools to test conformance [NIST] • http://xreg2.nist.gov/cda-validation/validation.html

9. HSX CCD Elements – Discharge Info Use Case

10. Start Simple and Build Upon Approach Crawl, Walk, Run… DIRECT Messaging via HISP (Years 1 -2) • Introduction of DIRECT secure messaging • Enablement of 2 use cases: • Discharge Information • Medication / Clinical History • Onboarding of HSX stakeholders • 4 large health systems • 9 community hospitals • 2-3 health plans Introduction of Query Based Exchange (HIE) (Years 3-4) • Continued onboarding of HISP services to HSX stakeholders • 3-4 large health systems • 8-10 community hospitals • Additional health plans • Introduction of robust HIE • Introduction of new HSX use cases Identification of new healthcare stakeholders for participation in HSX

11. HSX State Alignment HSX Technology Architecture – Direct Operations HSX Core Services • Certificate Authority • Health Entity Directory(Entity and Provider Directory) • State Direct Gateway Services PA Patient & Provider Network (P3N)* HSX Services Platform Enhanced DIRECT Services • HSX ENHANCED FEATURES • Automated PCP Finder • Automated Clinical Activity History IDNs Hospitals Behavioral Health Providers Physician Offices Routing intelligence and claims data to care team FQHC Private HISP Payers LTC • Connectivity Options • WebMail • Internal EHR inbox • HISP to HISP • *Relevant P3N Services • Statewide Provider Directory • DIRECT-enabled State Registries Long-term member opportunities City Clinics HSX Members * Note: Members and external data sources are intended to representative and for illustrative purposes only. They may not be inclusive of all HSX member types and external data partners.

12. HSX and State Alignment(continued) IMPROVING YOUR CARE THROUGH THE EXCHANGE OF HEALTH INFORMATION HSXs role with the PA eHealth Partnership Authority: Part of PA HIT Plan Represented on Authority Board Supports State Committees Supports P3N(PA Patient & Provider Network)Services Multi-State Exchange: PA and HSX Hosted a Multi-State Exchange Forum. NJ, PA, MD, DE, DC HIT Coordinator Offices and HIEs gathered to discuss synergies. Future sessions planned in 2014/15.

13. Lessons Learned on Vendors’ Readiness** **Only 13% of office-based physicians reported an intention to participate in the EHR incentive program and had a system meeting 14 of the 17 Stage 2 core objectives, according to a report released this week from the CDC's National Center for Health Statistics (NCHS).The Gupta Guide, January 17th, 2014. • EHR Certification and MU Stage 2 Readiness • Direct Enabled (XD, SMTP) • CCD and CDA Exchange Capability • Provider Directory Capability: • HSX intends to provide aFederated PD Model (HPD+) • Market Limitations and Inability of Vendors to Support HPD+, Results in HSX Developing Interim Approach to Manage Directories.

14. Key Challenges and points for discussion…. Aligning commitment and harmonization of systems Standing up a unified and accurate healthcare provider directory Integrate workflows and disparate systems How best to implement query along with Direct Use Case development governance

15. Thank You! Contact Information: Jonathan Sternlieb, M.D., F.A.C.G. Chief Medical Information Officer Holy Redeemer Health System 1602 Huntingdon Pike, 2nd Floor Meadowbrook, PA 19046 Mobile 267-278-3239 jsternlieb@holyredeemer.com Martin Lupinetti Executive Director HealthShare Exchange of Southeastern Pennsylvania, Inc. 1801 Market Street, Suite 750 Philadelphia, PA 19103 martin.lupinetti@hsxsepa.org 609.792.3896 www.hsxsepa.org